Medicine in India

Preface: I've had Dupuytren's contracture in my left hand for a number of years and lately it's been getting worse, so much so that it's time to get it fixed. Given the cost of medical care in the US and that repair is fairly straightforward and commonplace, I decided to see what having it fixed in India was like.

It's 9:00 AM and I've tried calling the surgeon's two landlines to no avail. Dare I try his mobile? I do. He answers himself and says he'd be happy to provide a consult, just come down to the hospital and ask for his office at the Enquiry window. I tell him I'll be right down. 15 minutes and a 50¢ auto ride later, I'm standing at the Enquiry window at Ashwani hospital. Just then, a tiny little gal comes up and motions me to follow her. She doesn't speak a word, just beckons. At this point I'm not sure what's going on -- is she taking me to someone who speaks English? That might be good, so I follow. Ashwani is a private hospital and it's big -- well, probably not so big compared to UCSF or the like, but still... So I follow her up ramps and down corridors and through a warren of rooms until I'm shown to Dr Raman's office. Well, I've been expected! That's a relief.

Dr Raman's office is pretty rudimentary: about 20' x 10' with a desk in front and a tiny exam table behind, separated by a curtain. A few books, a sink and that's about it. Dr Raman himself is about 60-65, small brown and friendly. I thrust out my hand and say "Dupuytren's". He pokes the strained tendons, asks a few questions (Any trouble with your feet? Penis? Are you diabetic?) and then it's my turn to ask the questions. I'm concerned about a recurrence after surgery and he tells me it's unlikely. Any other post-surgical complications? "Yes, infection. Especially with you foreigners. You're not used to our germs." I had to laugh, having had some experience with hospital acquired infections in India, of which I won't go into detail. I ask about the surgery itself: local or general? Local, with a brachial block.

At this point I notice that after 5 minutes he's summed me up and is talking to me as an equal, not as some white-coated condescending priest of the "Medical Establishment". What a relief! No bullshit, no carefully guarded answers the lawyers have trained them to mouth, just an honest exchange of questions and answers and information.

He starts to explain the bystander system, but I know about that so he goes on. In India, you need someone with you when you go to hospital to act as an advocate, gopher and whatever. Maybe it's a requirement so they have someone to haul the body away if something goes wrong? I don't know. Surgery itself will take 45 minutes, but he wants me there for 8 hours, or until the sedation wears off. Stitches come out in 2 weeks and I tell him I heal quickly so it might be a few days before that (I've learned this the hard way -- having stitches pulled through healed flesh hurts!) He replies telling me that hands tend to heal more slowly that the rest of the body. I tell him I'm prone to keloid formation and he says not to worry, hands are an exception (True? I don't know).

Cost? 15,000 Rs. ($326).

That's sound about right. Mind you, this is a private hospital and a private doctor, so he's paying for the operating room (theater, they still call it down there), his office, and god knows what else. 15,000 is no small sum, either, and I have a hunch much of it is going to him; as is proper because I'm paying for his experience and knowledge. I wonder if he has malpractice insurance? ~snicker~

So that's about it. Just call him to make an OR appointment and then get the damned thing fixed. Easy-peasey. I can only imagine what it'd be like trying to get this done in US without insurance. Perhaps we could learn something from the Indian system? It's my hunch the damn lawyers are what have screwed it up so badly, and I'll give you two examples. First; I'm prone to boils and have learned the hard way it's better to have a sebaceous cyst excised BEFORE it gets infected and turns ugly. I had a doctor in Ohio who always sent them in to pathology afterwards, at a cost of $60 each. Why? Oh, the one-in-a-million chance the cyst wasn't a sebaceous cyst. The lawyers make him do it, you see. Better safe than sorry. Cui bono?

THIS speaks for itself. I can't get my teeth cleaned without indemnifying my dentist in proper legalese.



Anonymous said...

Funny story. Keep 'em coming.

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